Cleft Surgery Research Articles

Constructing of predictive model for the surgical effect of patients with cleft lip and palate.

To explore effective factors of surgical effect for patients with cleft lip and palate, and to construct the predictive model of surgical effect, which provide reference for improving the effect of cleft lip and palate surgery. This study has been ethically reviewed and approved by the Medical Ethics Committee of Guiyang Stomatological Hospital before the study began.A total of 997 cases of cleft lip and palate surgical treatment in Guiyang Stomatological Hospital from 2015 to 2020 were collected. Logistic regression analysis was used to analyze the factors influencing the surgical outcome, and a score system was established by assigning values to the influencing factors using the nomogram. Data of 110 patients were verified, and decision curve analysis was used to evaluate the predicted results. Logistic regression analysis showed that the number of surgeries, surgical methods, breast milk, prenatal examination, nutrition during pregnancy and labor intensity during pregnancy were independent risk factors for poor surgical results (all P<0.05). The predictive model was built by including the number of surgeries, surgical methods, breast milk, prenatal examination, nutrition and labor intensity during pregnancy into the predictive scoring system. The critical value was 273, the area under ROC curve (AUC) was 0.733(95%CI:0.704~0.76), the sensitivity was 89.57%, and the specificity was 48.14%.When the external validation data of 110 patients were brought into the score, the AUC of poor diagnostic value reached 74.5%, P<0.05, which was close to the modeling accuracy of 73.3%. This study constructed a predictive model of surgical effect for patients with cleft lip and palate, which can be used for the clinical prediction of cleft lip and palate patients in Guizhou Province.

Differences in the stability of the lesser and greater maxillary segments after cleft orthognathic surgery: A retrospective study using 3D analysis

The aim of this study was to determine whether significant differences in postoperative stability exist between the lesser and the greater maxillary segments after cleft orthognathic surgery in patients with and without residual alveolar cleft.A retrospective study of orthognathic patients with unilateral cleft was conducted. The patients were divided into two groups according to maxillary status before surgery, with group 1 comprising single-piece maxilla and group 2 comprising two-piece maxilla. Four maxillary points were used for intra- and intergroup comparisons of movements and relapses between the two maxillary segments.In total, 24 patients were included. The intragroup comparison showed significant differences in vertical relapses between lesser and greater segments in both group 1 (anterior, p = 0.004 and posterior, p = 0.01) and group 2 (posterior, p = 0.013). With regard to intergroup comparison, the lesser segments in the two groups differed in transverse movements (anterior, p = 0.048) and relapses (posterior; p = 0.04), while the greater segments differed in transverse movements (anterior, p = 0.014 and posterior, p = 0.019), with significant differences in relapses anteriorly (vertical, p = 0.031 and sagittal, p = 0.036) and posteriorly (transverse, p = 0.022).Maxillary changes following cleft orthognathic surgery showed significant differences between the lesser and the greater segments. These findings imply that 3D images should be used to assess each maxillary segment separately with regard to planning and outcome evaluation.

The role of primary surgery in the management of orofacial clefting.

Primary cleft surgery refers to the planned surgical procedure(s) necessary to reconstruct an orofacial defect according to a specified protocol; in the context of a unilateral cleft lip and palate, this would include lip repair (with vomer flap closure of the hard palate), subsequent repair of the residual soft palate cleft and finally, the alveolar bone graft. This paper will provide an overview of the goals of primary surgical reconstruction, including the utility of pre-surgical orthopaedic techniques, including nasoalveolar moulding. The surgical methods of primary lip repair in both unilateral and bilateral clefts will be outlined and the concept of a primary rhinoplasty will be introduced. The principal techniques of cleft palate reconstruction will be delineated for a variety of cleft phenotypes. The final element of the primary reconstructive sequence is the alveolar bone graft using cancellous bone harvested from the iliac crest at approximately 8-10 years of age. The role of optimising oral hygiene prior to bone grafting cannot be over-emphasised and the utility of pre-surgical orthodontic arch expansion is also discussed. In the UK, bone graft outcomes are audited using the Kindelan score, which is evaluated from the six-month postoperative upper standard occlusal radiograph.

Identification and quantification of growth factors involved in growth and development of cartilage present in exosomes of lactating mother’s milk of cleft infant as compared to non-cleft infant – a protocol for an analytical observational study

Background: Cleft lip and palate (CLP) have complex etiology and even after successful cleft surgeries in a CLP child, there are chances of relapse as there may be a lack of something at the cellular level. Several growth factors like TGF-β, IGF, and BMP7 are involved in modulating chondrocyte homeostasis and can also induce chondrogenic differentiation in the bone marrow. Objectives: To identify growth factors involved in the growth and development of cartilage present in exosomes of lactating maternal milk of cleft and non-cleft children. Methodology: There will be two groups: GROUP-A: The lactating mother of a CLP child. GROUP-B: The lactating mother of a non-cleft child. Mothers with a CLP child and a non-cleft child between the age of 0–6 months will be selected for the study. The need for the study will be explained to the mothers and consent will be taken. A milk sample of 2ml will be collected in a falcon tube and transported in cold storage facilities to the laboratory. Initially, the isolation of exosomes from milk samples will be done, from which total proteins will be isolated by centrifugation process. This will be followed by an analysis of growth factors from the isolated total proteins (from both exosomes) through immunoblotting. Once the analysis is done, the quality and quantity of growth factors responsible for cartilage growth and development will be compared. Expected results: Isolated maternal exosomes are expected to contain an ample amount of growth factors involved in cartilage growth and development, highlighting its potential for use as a therapy alongside prevalent procedures in CLP. Conclusion: In this study, we expect that maternal exosomes act as a carrier of factors that can have therapeutic significance to the natural compensation of the cartilage to maintain nasal symmetry by naso-alveolar molding.

Can the exoscope be a game-changer for cleft palate surgery?

Cleft palate surgery represents a challenge for cleft surgeons, due to functional implications of an adequate reconstruction of the palate in a narrow operative field [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . Surgical loupes remain the mostly used magnification system for soft palate repair all over the world, with some drawbacks: restricted magnification capacity, offering a poor ergonomic posture, and limited surgical staff involvement. Furthermore, it is estimated that about 83% of cleft surgeons suffer from work-related musculoskeletal disorders and palate surgery can be considered one of the most uncomfortable procedures [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . The introduction of the microscope [2] Sommerlad B.C. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003 Nov; 112: 1540-1541https://doi.org/10.1097/01.PRS.0000085598.26409 Crossref PubMed Scopus (0) Google Scholar for the video-assistance of cleft palate surgery offered stereoscopic vision with higher magnification capabilities, a better ergonomic position and, by connecting a monitor, a better involvement of the surgical staff. However, its use in pediatric transoral surgery presents some difficulties in terms of adaption and challenging setting: for these reasons, the microscope is widely used only for dissection of the muscular plane, limiting its advantages and increasing the surgical times with its setting and dismissal.

Cleft lip and palate surgery during COVID-19 pandemic in Indonesia: a 36-month experience at the Bandung Cleft Lip and Palate Center.

In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Data from 18-month periods before (n = 460) and during (n = 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n = 230; pandemic, n = 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p = 0.904). Palatoplasty procedures were also compared (pre-pandemic, n = 160; pandemic, n = 139); the treatment protocol (patient 0.5-2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p = 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it.

To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it. A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated. Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036). The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Number and timing of primary cleft lip and palate repair surgeries in England: whole nation study of electronic health records before and during the COVID-19 pandemic

ObjectiveTo quantify differences in number and timing of first primary cleft lip and palate (CLP) repair procedures during the first year of the COVID-19 pandemic (1 April 2020 to 31...

Postoperative Dysnatremia in Pediatric Patients Undergoing Palatoplasty.

Identifying predisposing factors to dysnatremia to improve perioperative care after cleft surgery. Retrospective case series. Patient data were obtained through the electronic medical records of the hospital. Tertiary care university hospital. The inclusion criterion was the measurement of an abnormal natremia value, defined as Na >150 or <130mmol/l after a cleft lip or cleft palate repair procedure. The exclusion criterion was natremia between 131 and 149mmol/l. Natremia measurements were available for 215 patients born between 1995 and 2018. Five patients presented with postoperative dysnatremia. Several predisposing factors to dysnatremia have been identified: drugs, infection, administration of intravenous fluids, and postoperative syndrome of inappropriate antidiuretic hormone secretion. Although the hospital environment contributes to dysnatremia development, the fact that only patients undergoing cleft palate repair develop natremia anomalies suggests that this surgery may be itself a risk factor. Children undergoing palatoplasty may be at higher risk to develop postoperative dysnatremia. Early recognition of symptoms and risk factors, postoperative monitoring, and prompt treatment of dysnatremia diminish the risk of neurological complications.

774 Providing Essential Burn Reconstructive Surgery in Resource-Limited Environments Using a Cleft Organization

Abstract Introduction Cleft non-governmental organizations (NGOs) collaborate with multidisciplinary teams of healthcare professionals to provide safe and effective cleft surgery in resource limited environments. Unfortunately, other significantly disabling conditions like burns, which require similarly multidisciplinary reconstructive interventions, often lack the same degree of local and international support. Therefore, cleft NGOs are well positioned to support essential reconstructive burn care through sustainable service delivery models like those developed for cleft care. Methods An NGO with experience delivering global cleft care established a collaborative effort in COUNTRY between local and international burn experts from to provide burn care. Preoperative screening was performed by a local burn surgeon to identify patients. Virtual conferences were held bi-weekly to discuss candidates and operative planning. Following 3 months or preparation, a 5-day surgical program with a mixed team of COUNTRY and international volunteers was held. Patient demographics, interventions, and outcomes were monitored to determine efficacy of this Cleft NGO at delivering essential burn reconstruction. Results Of the 52 burn patients who were screened, 32 were surgical candidates, and 20 received a total of 26 surgeries during the 5-day program. Average age was 17 ± 16 years with 65% (13) females and 25% (5) refugees. Most had scald (65%) or flame (30%) burns from household accidents with average age at burn of 8 ± 12 years. Random pattern flaps were used in all cases. Only 1 patient required supplementary skin grafting. Seven patients had multiple operative sites that were addressed with a 2-team approach. No perioperative complications occurred. All patients were followed-up by the in-country team between 7 and 42 days. Five patients presented with minor complications - 5 flaps with partial necrosis and 2 partial dehiscence. None required surgical intervention. Conclusions Cleft NGOs have the resources and experience that allows them to implement impactful surgical programs for other conditions that are critically lacking access to essential reconstructive care. Applicability of Research to Practice Cleft NGOs can provide safe and effective burn surgery through collaborative local and international efforts aimed at sustainability and capacity building.

Encountering bodies and identity dynamics of social worker: A case of a cleft lip and palate surgeries department

This article highlights social work practices for children with cleft lip and palate (CLP) and their families in a hospital. Embodiment is the main theoretical perspective used to analyse complex encounters between clients (children with CLP and their parents) and social workers in concrete interactive situations. It allows us to symmetrically reflect on how encounters between the bodies of clients, the social worker and medical professionals co-construct and redefine the social worker’s identities. Three body-related identities emerge and coexist as the practice proceeds: a normal person with a normal life, a learner without embodied knowledge of a particular illness and a professional with both medical and social work authorities. These three dimensions show how mutual embodiment in contextualised interactions affects the social worker-client relationship. About implications for social work practice, we draw attention to the situated identities of social worker in a specific context, and explain how embodiment serves as a critical tool to improve our understanding of practitioners’ dynamic identities through embodied reflexivity.

The Use of Eye-tracking Technology in Cleft Lip: A Literature Review.

The PubMed, Google Scholar, and Cochrane databases were searched to identify all articles published up to August 2022. All articles were screened by two independent reviewers. Inclusion criteria included using eye-tracking, image stimuli of CL+/-P, and outcome reporting using areas of interest (AOIs). Exclusion criteria included non-English studies, conference articles, and image stimuli of conditions other than CL+/-P. Forty articles were identified, and 16 met the inclusion/exclusion criteria. Thirteen studies only displayed images of individuals following cleft lip surgery with three only displaying unrepaired cleft lips. Significant variation was found in study design, particularly in the AOIs used to report gaze outcomes. Ten studies asked participants to provide an outcome score alongside eye-tracking; however, only four compared outcome data to eye-tracking data. This review is primarily limited by the minimal number of publications in this area. Eye-tracking can be a powerful tool in evaluating appearance outcomes following CL+/-P surgery. It is currently limited by the lack of standardized research methodology and varied study design. Before future work, a replicable protocol should be developed to maximize the potential of this technology.

Cleft Lip and Palate Repair Surgeries in a Tertiary Care Center: A Descriptive Cross-Sectional Study

Introduction: The burden of cleft lip and palate in Nepal is high. Surgeries should be performed at the right age and weight for the safety and optimal development. We aimed to identify the socio-demographic and peri-operative attributes of cleft lip and palate patients. Methods: A descriptive, cross-sectional study of cleft lip and palate surgeries conducted in Tribhuvan University Teaching Hospital, over a two-year period. Variables studied include age and weight at the time of surgery, gender, ethnicity, type of repair, other congenital defects, the length of stay, and complications. Results: Overall, 28 cleft lip and palate surgeries were performed. The median age at operation of cleft lip patients was six months and of cleft palate patients was 20.5 months. The median weight in kilograms of cleft lip patients was six, whereas of cleft palate patients was 10. The male-to-female ratio among all the patients was 1.2:1. The patients hailed from all seven provinces of Nepal. For cleft lip, Millard technique 13 (93%) was most commonly performed and for cleft palate, the Bardach repair 10 (71.4%) was mostly preferred. Only two patients suffered from peri-operative complications. Conclusion: Millard technique and Bardach repair were the most commonly performed surgeries for cleft lip and palate respectively. Two peri-operative complications were encountered.

Evaluation of Flexibility and Thickness of Cleft Lip Scars After Treatment with Microneedling Technique: a Cohort Trial.

The early surgical treatment of the cleft lip led to a postoperative scar formation which may affect the physiological and psychological aspects of the patient. Evaluating the improvement rate of thescar flexibility and thickness of the cleft lip scar after treatment with the micro-needling. Sixteen patients (12 females and 4 males), aged 16-30 years who had a cleft lip scare were included in the current study. All patients suffered from a visible defective scar in the upper cleft lip. All patients were treated with a microneedling pen device combined with topical application of oil-based hyaluronic acid. The procedure was performed in 4 sessions with 3-week intervals between sessions. The scars were assessed by the patient and an external observer using the Patient and Observer Scar Assessment Scale. Thickness of the scar was improved according to the patient and observer opinions (67.28% and 61.55% respectively). Flexibility was improved according to the patient observer opinion (65.57% and 60.25% respectively). Microneedling treatment can be considered as an effective method for the treatment of the defective scars resulting from the cleft lip plastic surgery. The microneedling technique is a simple, easy, safe, non-invasive, and low-cost procedure.

The role of Botulinum toxin type A for prevention and treatment of cleft lip palate (CLP) post-operative scar: a systematic review

Background. Cleft lip palate (CLP) defects are the common orofacial defects found in newborns. The main treatment is lip and palate surgery, often resulting in a hypertrophic scar that significantly affects the patient's aesthetic appearance. Several studies showed the role of Botulinum toxin type A injections for prevention and treatment of CLP post-operative scarThis systematic review aims to review the role of Botulinum toxin type A for prevention and treatment of cleft lip palate surgery scar. Method. Online databases were searched for relevant studies from Google Scholar, PubMed and ProQuest. Data sources were searched using MeSH terms "botulinum toxin," "cleft lip palate," and "surgery scar" for all publications up to October 2022. All English papers regarding the role of Botulinum toxin type A in preventing and treating CLP post-operative scar were included. Papers not available in full text or English and not an experimental study were excluded. Result. Six studies are included in this systematic review consisting of three randomized controlled trials and three clinical studies. The experimental group received Botulinum toxin type A injections, while the control group received an injection of normal saline or other topical treatment. All of the included studies showed positive results regarding the role of Botulinum toxin type A marked with reduced scar width, good Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS), patient satisfaction and no complications or side effects were found. Conclusion. The Botulinum toxin type A showed promising results for the prevention and treatment of CLP post-operative scar.

PC17. Implementation of an Enhanced Recovery after Surgery Protocol for Cleft Palate Repair

PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cleft surgery, to decrease hospital stays and improve outcomes. The authors aim to describe the implementation of an ERAS protocol for cleft palate repair at a tertiary care hospital. METHOD: Patients undergoing cleft palate repair at the authors’ institution over a 10-year period were collected (n=242). Cleft demographics and operative details were collected. Primary outcome measures were hospital length of stay (LOS) and narcotic usage. Secondary outcome measures were fistula development and need for speech surgery. Chi-square tests and independent t-tests determined significance. RESULTS: Infiltration with bupivacaine was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased hospital LOS (p < 0.01). Utilization of the Furlow palatoplasty was associated with decreased hospital LOS (p < 0.01). Patients using the ERAS protocol experienced shorter LOS (p < 0.01). Fistula development was associated with increased 24-hour morphine equivalent usage (p < 0.01). Need for speech surgery was associated with increased 24-hour morphine equivalent usage (p < 0.01) and increased hospital LOS (p < 0.05). CONCLUSION: This study reiterates the benefit of an ERAS protocol for patients undergoing cleft palate repair. The protocol resulted in decreased LOS and narcotic use. The finding regarding fistula formation and need for speech surgery requiring increased narcotics may indicate that the initial postoperative period is vital to adequate wound healing and subsequent outcomes. This study has implications for ways to maximize hospital reimbursement, as well as potentially improve outcomes.

D112. Digital Simulation for Cleft Surgery Education: A 10-year Assessment of Global Impact

D112. Digital Simulation for Cleft Surgery Education: A 10-year Assessment of Global Impact

Postoperative Daycare as a Safe and Cost-Effective Option for Secondary Alveolar Bone Graft (SABG) Surgery: A Retrospective Comparative Cohort Study.

To evaluate the outcomes of Secondary Alveolar Bone Grafting (SABG) in patients treated either in daycare or with multiple day hospitalization (MDH) in relation to costs and complication rates. Retrospective comparative cohort study. The data was collected from two settings: Postoperative daycare or MDH after oral cleft surgery in an Academic Medical Center in The Netherlands. Data of 137 patients with unilateral Cleft lip, alveolus, and palate (CLAP) treated between 2006-2018 were evaluated. Registered clinical variables: age, gender, cleft subtype, bone donor site, type of hospitalization, length of stay, additional surgery, complications, surgeons, and costs. Closure of the alveolar cleft with/without closure of the anterior palate. Univariate analyses. Of the 137 patients, 46.7% were treated in MDH, and 53.3% in daycare. Total costs for daycare were significantly lower (P < .001). All patients treated in daycare received mandibular symphysis bone, whereas in MDH, 46.9% received iliac crest bone instead. Bone donor site was associated with postoperative care type. Complication rates were slightly but not significantly higher in daycare (26%) vs. MDH (14.1%) (P = .09). Most were Grade I (minor) according to Clavien Dindo classification. Daycare after alveolar cleft surgery is about as safe as MDH, but significantly cheaper.

Piezoelectric instrumentation in secondary cleft rhinoplasty: Techniques and clinical experience

Cleft rhinoplasty is a challenging procedure, with precision required to achieve good results. Cases often present with more complex structural and soft tissue asymmetries than non-cleft cases. Piezoelectric instrumentation uses ultrasonic vibrations to cut bone. At certain frequency, it will only cut bone, sparing soft tissue and is reported to decrease postoperative pain, oedema and echymosis. It allows nasal bony work to be performed under direct vision without losing stability of the bony fragments by preserving the underlying periosteum. There is good evidence on the use of piezoelectric instrumentation in cosmetic rhinoplasty; however, none to date has focused exclusively on cleft rhinoplasty. We present a single surgeon experience using piezoelectric instrumentation in cleft rhinoplasty. We reviewed the case histories of 21 consecutive patients who had Piezo-assisted cleft rhinoplasty surgery between 2017 and 2021. We present our operative techniques and results of piezoelectric cleft rhinoplasty and compare it with 19 patients undergoing cleft rhinoplasty with conventional instrumentation over the same time period, by the same surgeon. Piezo-assisted rhinoplasty steps included bony osteotomies, dorsal hump removal, modification of composite cartilage/ ethmoid grafts and instrumentation of the anterior nasal spine. There were no significant complications and no revision surgeries. There was no difference in operative time compared to conventional instruments. Piezoelectric instrumentation is a valuable and efficient tool in cleft rhinoplasty. It offers potentially significant advantages in terms of the precision of bony work, whilst minimising trauma to the surrounding soft tissues.

Do Buccal Flaps Improve Velopharyngeal Insufficiency in Conversion Furlow Palatoplasty for Patients with Cleft Palate?

Velopharyngeal insufficiency (VPI) is a complication following primary palatoplasty that can lead to hypernasality of the voice and other speech problems. The conversion Furlow palatoplasty for VPI can be performed with the addition of buccal flaps to provide additional tissue for palatal repair. In this study, the authors aimed to determine the effectiveness of buccal flaps with conversion Furlow palatoplasty in secondary management of VPI. A retrospective review of patients undergoing surgical repair of VPI between 2016 and 2020 was performed. Patients underwent either conversion Furlow palatoplasty alone (FA) or conversion Furlow palatoplasty with buccal flaps (FB) for VPI after primary straight-line repair of the palate. The authors reviewed medical records to collect demographics, operative information, and preoperative and postoperative speech scores. Of the 77 patients in the study, 16 (21%) had a revision that incorporated buccal flaps. The median age at cleft palate revision surgery was 8.97 years in the FA group and 7.96 years in the FB group ( P = 0.337). In the FA group, four patients (7%) developed a postoperative fistula, compared with zero patients in the FB group. The average time to follow-up after revision surgery was 3.4 years (range, 7 months to 5.9 years). Both cohorts demonstrated a decrease in hypernasality and total parameter scores postoperatively. The use of buccal flaps in revision Furlow palatoplasty could decrease the risk for postoperative complications. The use of data from a larger patient population from multiple institutions is warranted to determine true significance. Therapeutic, III.